<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('工厂名字')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" data-rule="required" class="form-control" name="row[name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('手机号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" data-rule="required" class="form-control" name="row[mobile]" type="tel">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('负责人姓名')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-username" data-rule="required" class="form-control" name="row[username]" type="text">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('押金')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ya" data-rule="required" class="form-control" name="row[ya]" type="number">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('对公结算卡号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bank_card" data-rule="required" class="form-control" name="row[bank_card]" type="number">
        </div>
    </div>

    <div class="form-group">
        <label for="c-yyzz" class="control-label col-xs-12 col-sm-2">{:__('营业执照')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-yyzz" data-rule="" class="form-control" size="50" name="row[yyzz]" type="text" >
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-yyzz" class="btn btn-danger faupload" data-input-id="c-yyzz" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-yyzz"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-yyzz" class="btn btn-primary fachoose" data-input-id="c-yyzz" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-yyzz"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-yyzz"></ul>
        </div>
    </div>

    <div class="form-group">
        <label for="c-zz" class="control-label col-xs-12 col-sm-2">{:__('资质')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-zz" data-rule="" class="form-control" size="50" name="row[yyzz]" type="text" >
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-zz" class="btn btn-danger faupload" data-input-id="c-zz" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-zz"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-zz" class="btn btn-primary fachoose" data-input-id="c-zz" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-zz"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-zz"></ul>
        </div>
    </div>

    <div class="form-group">
        <label for="c-ya_img" class="control-label col-xs-12 col-sm-2">{:__('押金转账凭证')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-ya_img" data-rule="" class="form-control" size="50" name="row[ya_img]" type="text" >
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-ya_img" class="btn btn-danger faupload" data-input-id="c-ya_img" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-ya_img"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-ya_img" class="btn btn-primary fachoose" data-input-id="c-ya_img" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-ya_img"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-ya_img"></ul>
        </div>
    </div>



    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('登录密码')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-password" data-rule="required" class="form-control" name="row[password]" type="text">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('备注')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mark" class="form-control" name="row[mark]" type="text">
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
